Fear, pain and letting it rip: How pitchers are forging ahead despite an elbow ‘pandemic’

One doctor encouraged Triston McKenzie to rest. Another doctor encouraged him to have his elbow reconstructed. The decision ultimately landed on the Cleveland Guardians pitcher last summer, and he initially had “no clue.”

He opted for rest, and eight months later, he feels no pain. He has no regrets. But he admits he can’t possibly know yet if he made the right decision. How could he know? Elbow injuries are plaguing the entire sport. No one has unearthed a singular cause nor a surefire means of prevention.

McKenzie only needs to peer one locker to his left in Cleveland’s clubhouse for evidence. That stall will sit empty for much of this year, as its occupant, Shane Bieber, rehabs from Tommy John surgery in Arizona. The Guardians ace didn’t allow a run in two starts this year, but he knew his elbow was on borrowed time. When he walked off the mound in Seattle at the end of a start two weeks ago, he had an inkling his season was over.

The news of Bieber’s elbow surgery dominated MLB headlines … for about an hour, until the MRI results of Braves ace Spencer Strider became public knowledge. Strider underwent elbow surgery on Friday.

Some pitchers can’t shake the thought that they will be the next one to suffer a season-wrecking elbow injury.

“It’s always in the back of my head,” McKenzie admitted.

He’s not the only one haunted by the elbow plague.

As Guardians pitcher Tanner Bibee recited his short list of career arm injuries — a shoulder impingement in college, a bone bruise in his elbow in high school — he knocked on a wooden wall to ensure he wasn’t jinxing his health. Orioles ace Corbin Burnes outlined his offseason conditioning regimen, modified to adapt to the demands of the pitch clock, and he noted other pitchers have made similar tweaks to their training and have remained healthy.

“Knock on wood,” he said.

There’s a lot of that going around: hoping and wishing for continued health, because no one has unearthed a magic elixir to keeping elbows safe and many are unwilling to scale back their pursuits of a harder heater or a sharper sweeper. Every time pitchers take the mound, they do so knowing that the chances are higher than ever that they will suffer a catastrophic injury. Some consider that risk simply a prerequisite to surviving in the big leagues, in an era where pitchers push their bodies like never before; 275 pitchers in professional baseball had Tommy John surgery last season, up from 190 in 2016.

“Everyone goes out there knowing that injuries are part of the game,” said Rays closer Pete Fairbanks, “whether we like it or not.”

It’s a topic that’s top of mind in dugouts and bullpens across the league. Pitchers are wondering what’s causing their elbows to crumble. They’re talking about it. They know they can’t hide from it.

“There’s really going to be no stopping of this pandemic,” said Reds pitcher Tejay Antone, who underwent his third Tommy John procedure on Friday.

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Tyler Mahle signed a two-year deal with the Rangers over the winter even though he underwent Tommy John surgery last May. Liam Hendriks inked a multi-year contract with the Red Sox even though he underwent Tommy John surgery in August. Hendriks said he felt elbow pain throughout his rehab assignment last year as he worked his way back from non-Hodgkin lymphoma.

“There was no way I wasn’t getting back last year,” he said. … “The elbow was gone no matter what. So, I’m not sitting there to try to rehab another six weeks potentially and not come back.”

And he had no plans to trudge ahead cautiously.

“F— no,” he said. “I don’t baby it.”

Hendriks said he’s long held the belief that when he holds back and doesn’t exert maximum effort, that’s when he dangles his arm in harm’s way.

That’s Antone’s philosophy, too. Antone, whose first name is quite the dose of irony, said he intends to keep pitching even after a third elbow reconstruction. The 30-year-old debuted in 2020, but once he recovers from this latest operation sometime next year, he’ll have totaled only 45 big-league appearances in a five-season span.

“This is going to be a war to get this done,” he said, “and it’s going to be tough, but I’m going to go for it.”

In 2021, Antone suffered a small flexor tear, which necessitated the surgery. This time, he said, the muscle fully detached from the bone. He had an internal brace installed instead of his own tendons, “because obviously my tendons don’t work very well.”

Antone surmised the spate of elbow injuries is tied to pitchers chasing velocity, and he said he has no plans to stop chasing. His fastball reached the mid-90s before his first elbow procedure in 2017. When he returned, he topped out at 100 mph. After the second surgery, he topped out at 101 mph. He joked he might reach 103 mph once he recovers from this latest operation.

“Those are the demands of the sport, and it’s our job to do our best to meet those demands,” said Fairbanks, who had Tommy John surgery twice before he reached the majors in 2019. Fairbanks’ fastball velocity spiked the past two years, averaging 99 mph, up two ticks from his first three seasons in the majors. Teams value — and pay for — velocity, so pitchers pursue it, armed with gadgets and data that push them past their perceived limits.

“If you’re not trying to add velocity or add a pitch,” said Cubs starter Jameson Taillon, another member of the Two Tommy Johns Club, “(you’re) probably falling behind.”

The alternative — throwing a nice, soft fastball — isn’t appealing to pitchers.

“That is the safest thing to do,” said Lucas Giolito, who underwent season-ending elbow surgery last month. “But you’re going to get hit around the park.”

When Taillon entered pro ball in 2010, he said, it was customary after a season to avoid baseballs until after Thanksgiving and to complete a first bullpen session in late January.

“Now, if you’re not 12 pens in going into spring training,” he said, “you’re behind everybody. It’s crazy.”

Jameson Taillon has seen significant changes in how pitchers train over his time in the majors. (Carmen Mandato / Getty Images)

Taillon said the first live bullpen session of the spring, once a milestone to mark the easing into a grueling schedule, now resembles “Game 7 of the f—ing World Series,” with every twitch and every pitch documented by Trackman software and biomechanics analysts. Six or seven years ago, he said, a pitcher could arrive at camp, throw a couple of bullpen sessions to build stamina, throw a live bullpen session “with no judgment,” and if someone swatted five of his pitches into the facility’s parking lot, no one would be concerned.

That evolution in year-round intensity and scrutiny, some pitchers say, has spawned a breeding ground for injuries. One veteran starter recalled throwing one suboptimal pitch in a bullpen session and having a coach ask what was wrong with him.

“I’m like, ‘I don’t f—ing know, dude,’” said the pitcher, granted anonymity so he could speak candidly. “I just threw seven innings on national TV two nights ago. I’m not f—ing dialed right now.’ It’s that instant feedback. ‘What’s wrong? That wasn’t perfect.’ They just expect pitchers to be absolute robots now.”

The motherboards on these robots are malfunctioning, though. Taillon mentioned Gerrit Cole and Justin Verlander, two longtime aces who rarely exhibited signs of breaking down until recently. Verlander missed the 2021 season because of Tommy John surgery and he’s on the shelf now with a shoulder issue. Cole is sidelined with nerve inflammation in his right elbow.

“You’re seeing workhorse-type guys going down,” Taillon said, “and that’s eye-opening to me.”

Verlander is 41 and has logged more than 3,300 innings in the majors. Taillon knows Cole well, having pitched alongside him with both the Pirates and Yankees.

“A guy like Gerrit, I don’t even think he gets sore like the rest of us,” Taillon said. “His mechanics are so fluid. He’s so strong. He’s so in tune with his body. That one, to me, was definitely a little eye-opening. I’ve watched the work he puts into it. I’ve seen him post up every fifth day and throw 98 (mph) with ease into the seventh inning every time. So it’s definitely a little alarming.”

What can be done? Taillon overhauled his delivery after his second Tommy John surgery because he “figured that was my body telling me that something’s not right.” But he admits he might have sacrificed some performance quality for health, and he understands why many pitchers would refuse such a tradeoff.

“Guys don’t want to fall behind,” Taillon said, “so they’d rather get hurt than get devalued.”

The surgery comes with a lengthy recovery time, but it’s not the doomsday diagnosis it once was. Mahle and Hendriks are proof that teams treat recovering pitchers differently than they might have a decade or two ago.

“Teams treat Tommy John guys as basically just a lost year and then they’re going to be exactly the same,” said reliever Bryan Shaw, who was pitching for the White Sox until he was designated for assignment last week. “You hope that, obviously, and that’s why you’re paying them, but you never know.”

Hall of Famer John Smoltz warns that’s a slippery slope, though.

“It’s a misconception that has been out there forever,” he said, “that people think, ‘Well, look at every guy’s comeback: They’ve thrown harder and they’ve been better.’ It’s a myth.

“Tommy John’s not normal. And we’ve normalized it.”

McKenzie isn’t standing atop the rubber worried that his elbow will explode with his next delivery, but with every twinge or bout of soreness, he said he wonders if he’s putting his elbow at risk. He’s still searching for his usual velocity, as he averaged 90.5 mph in a start against the Yankees on Saturday, down from 92.4 mph last year.

As he wrestled with his decision last June, he thought about the potential scenarios. He could have rested his elbow, returned from the injured list and then needed surgery at the end of last season. He could have undergone surgery and then hoped his stuff would rebound once he returned to Cleveland’s rotation late in 2024 or in 2025.

Or, the scenario he’s still attempting to avoid: three months of rest, that brief return at the end of last season, and then an eventual date with a surgeon in 2024, allowing this to spiral into a several-year nightmare. If it does? The sad reality is that he’ll have plenty of company in the rehab room.

“Anybody’s at risk,” said Cleveland manager Stephen Vogt, “at any time.”

The Athletic’s C. Trent Rosecrans, Stephen J. Nesbitt, Sam Blum and Andy McCullough contributed to this story.

(Top photo of McKenzie: Duane Burleson / Getty Images)